WALLACE J FORMHALS Pharmacist License verification

Business Entity

INACTIVE

License Type

Pharmacist

Description

REGISTERED PHARMACIST

License Number

051014432

License Status

INACTIVE

Business

First Name

WALLACE J

Last Name

FORMHALS

Business Name

WALLACE J FORMHALS

Original Issue Date

01/01/1997

Expiration Date

03/31/1984

City

LA SALLE

State

Zip

61301

County

LA SALLE

Ever Disciplined

LastModifiedDate

10/17/2005